This is an important point from Jerald:

“Thus, I believe most therapists never screen for or detect pathologic computer use in their patients. And, for those that do, I would guess that most consider the game (or internet) use a problem to be eliminated - not a psychological defense mechanism that may have value…”

RIGHT ON!!

The behavior is serving a purpose, and it’s critical that we understand what that purpose is.

From what I have observed, clinicians with established practices tend to be a bit older than the average gamer (okay, sometimes a lot older) and most are somewhat (or a lot) tech-illiterate. In my private practice I see people with obsessive game play (or other problematic behavior they are engaging in over the net) and family members are often entirely ignorant. Therapists don’t even ask about it, and don’t know what they’re hearing if the topic does come up. It’s almost willfull ignorance, as if the subject is frivolous and not worth discussing.

In my part-time clinic position, I regularly review charts and treatment plans done by other clinicians and often see “good at computer games” listed as a strength. They don’t even know what they’re writing about, how can they know the way that the gaming process is affecting this individual?

I’ve been saving stories from recent crisis contacts involving teen/parental violence precipatated by parents attempts to get them off the game. Maybe I’ll write up a few vignettes when I get a little time.

Good job Neils, and thanks Jerald.

Well butter my bread. That is fascinating. I need to find a source for that!

In terms of a preference for existence, well put. I think that we ultimately need to begin seeing MMO games as a media which adds another layer to culture. Just as television, cellphones, and other technologies give us very unique forms of experience, i.e. we watch Barney the Dinosaur, or we talk to Fred on our cellphone, games continue our human tradition of storytelling and experience. We have a desire, as JRR Tolkien said, “to survey the depths of space and time, and to hold communion with other living beings.” Games extend on old techs by giving us interaction with worlds, whether populated by fake people, real people, or rotating blocks.

They’re what I’d call a ‘real illusion’ It’s a world, but it sits in this interesting half-life (Isn’t that right Dr. Gordon Freeman). I think that as we get a research, and then societal understanding of what underlies problem play, that we may (depending on what we find) start to see games meant to balance a player’s success in the primary and secondary world. If not that, then at least have therapists who know what the hell a game is. =P

You note that a “good therapist” will weigh the pro and cons before stopping their patient’s game use. That implies a certain degree of knowledge on the part of the therapist - they have to understand how and why computers and the games are used. In my experience, some of the best therapists I know have scant knowledge in this area. Call it temperment or whatever, they are computer-phobic. I can’t tell you the number of case conferences that I have been to where the issue has been overlooked.

Thus, I believe most therapist never screen for or detect pathologic computer use in their patients. And, for those that do, I would guess that most consider the game (or internet) use a problem to be eliminated - not a psychological defense mechanism that may have value.

The Columbine shooter, Eric Harris, only began making actual plans to blow up his school after his parents banned him from computer access for about a month, on the advice of a therapist.

As for your theory on virtual vs. real life success, I believe they are generally inversely related. There are exceptions, like the people who have made a good living from their ebay stores or farming in MMORPGs. At any rate, success in the virtual may lead people to be confused as to where they exist… or prefer to, at any rate.

But here I go, opening a dozen different cans of worms…

Absolutely, computers can be and are used in unique defensive patterns. If a piece of software keeps somebody from committing suicide, then I’m all for it. It’s certainly not something to remove lightly. At the same time, and I’m sure you’d probably agree here, a good therapist is going to weigh the pros and cons of an individual’s computer use. Sometimes the gaming is causing more problems than it’s solving, and sometimes a gamer is going to need competent help in separating themselves from playing badly.

You note that in all likelihood, when removing games we play with fire, “the patient is then flooded with aggressive/self-destructive emotions. Some patients then seek out more destructive “aids” to help them avoid the unpleasant emotions.”

This is certainly the case. At the same time I’ve spoken with gamers who, after quitting MMO games, feel incredibly relieved. Maintaining functionality inside of a game world seems to consistently encroach on functionality for people’s real lives. At some point after quitting (maybe the day they quit, maybe six months later), they feel the draw of games, probably for a number of reasons all likely unique and based on what the game satisfied for them initially. That said, those who experience this, all likely feel a similar sensation of pull. It’s the dopamine reward button, and they want the game to be able to push it again.

It seems like we have a construct that is of immense value to some, like functional gamers as well as people with the Axis II disorders. At the same time, I can’t help but wonder if there are hooks in these games that can cause reasonably functional people to begin playing excessively.

I wonder if you have any opinions on this? I don’t really think that there are any right or wrong answers, because we have so many people doing work that is the opposite of helpful. One thing that’s really valuable is what you and Sara E. Allison, et. al. (that article discussed here, just scroll down a bit) are doing, in presenting the complexities. In this way we can begin going beyond Young’s base and basic criteria, presenting therapists with material that can actually help sharpen them to the nuances that lie in every patient.

With regards to pre-existing diagnoses, what I meant is that one finds something else that led to the game playing - OCD, depression, anxiety, Axis II personality disorder, etc.. The computer helps the individual deal with that issue. Thus, the depressed person might feel less isolated, the anxious person might feel safer, the OCD patient has a predictable, well-controlled place to play, and so on.

There is no rule, though. With the different types of disorders, the computer can be used defensively in unique ways to help that individual cope. The danger one sees when abruptly discontinuing the computer use is that we do not recognize the purpose behind the gaming. Thus, the computer is disconnected and with it the coping mechanism - the defense - is suddenly removed; the patient is then flooded with aggressive/self-destructive emotions. Some patients then seek out more destructive “aids” to help them avoid the unpleasant emotions.

I have never seen someone who just came in for excessive computer gaming and who did not have other issues that the gaming helped with. The symptom exists for a reason.

Incidentally, I agree with you. There is a need for better data and obtaining it will take some time.

Regards,

Jerald